SUBSTANCE ABUSE TRENDS IN TEXAS:

JUNE 2009
BY JANE C. MAXWELL, PH.D. GULF COAST ADDICTION TECHNOLOGY TRANSFER CENTER
THE ADDICTION -RESEARCH INSTITUTE U. T. CENTER FOR SOCIAL WORK RESEARCH

ABSTRACT

This report updates indicators of drug abuse in Texas since the June 2008 report and
describes trends by calendar year from 1987 through 2008. Important changes to drug
patterns in Texas include increases in heroin inhalation by younger Hispanics. This was
first noticed with the "cheese heroin" situation in Dallas, but further investigation has
found that heroin inhalation is increasing statewide. Some treatment admissions are
young teenagers who are not novices and are using other illicit drugs, and those in their
twenties are shifting to injecting. The availability of cocaine decreased in the last half of
2008 due to violence and gang warfare on the border. The methamphetamine indicators
have changed since 2005, with supplies down, prices increasing, and purity decreasing.
Border security and seizures of Mexican methamphetamine have encouraged local
manufacturers to return to “cooking,” using over-the-counter pseudoephedrine with the
“one pot” or “shake and bake” method. Other changes include continuing shifts in
demographics of cocaine users and ecstasy users; severity of problems among
noncoerced marijuana treatment admissions; and increasing problems with alprazolam
and carisoprodol. The magnitude of the substance abuse and mental health problem on
the border is of serious concern. The majority of human immunodeficiency virus (HIV)
and acquired immunodeficiency syndrome (AIDS) cases continue to be people of color.
The proportions due to injection drug use (IDU) continue to decrease, but the
proportions due to men who have sex with men (MSM) are beginning to increase.

AREA DESCRIPTION ƒ Student substance use data for 2008 came

The population of Texas in 2008 was 24,326,974, with
48 percent White, 11 percent Black, 36 percent
Hispanic, and 4 percent “Other.” Illicit drugs continue
to enter from Mexico through cities such as El Paso,
Laredo, McAllen, and Brownsville, as well as through
smaller towns along the border. The drugs then
move northward for distribution through Dallas/Fort
Worth and Houston. In addition, drugs move
eastward from San Diego through Lubbock and from
El Paso to Amarillo and Dallas/Fort Worth.
DATA SOURCES
Substance Abuse Trends in Texas is an ongoing
series that is prepared annually as a report for the
Community Epidemiology Work Group meetings
sponsored by the National Institute on Drug Abuse
(NIDA). This report updates the June 2008 report. To
compare the June 2009 report with earlier periods,
please access http://www.utexas.edu/research/
cswr/gcattc/drugtrends.html.
Data for this report include the following sources:
from the Texas School Survey of Substance
Abuse: Grades 7–12, 2008 and the Texas
School Survey of Substance Abuse: Grades 4–6,
2008, which were authored by L.Y. Liu and
published by the Department of State Health
Services (DSHS). Data on Texas college
students came from the 2005 Texas Survey of
Substance Use among College Students: Main
Findings, also written by L.Y. Liu and published
by DSHS. For 2007, the data for high school
students in grades 9–12 came from the Youth
Risk Behavior Surveillance Survey (YRBS)—
United States, 2007, MMWR Surveillance
Summaries, June 6, 2008/57(SS-4); 1–136.
• Data on drug use by Texans age 12 and older
came from the Substance Abuse and Mental
Health Services Administration’s (SAMHSA)
National Surveys on Drug Use and Health
(NSDUH). The statewide estimates are from the
2006-2007 NSDUH, and the substate estimates
in appendix 2 are from the 2004, 2005, and 2006
NSDUH surveys. Estimates for the Dallas and
Houston metropolitan areas are based on the
2005–2006 surveys.

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 1

• Poison control center data came from the
Texas Poison Center Network, DSHS, for 1998
through 2008. Analysis was provided by Mathias
Forrester, epidemiologist with the Texas Poison
Center Network, and by the author.
ƒ Treatment data were provided by DSHS’s data
system on clients admitted to treatment in DSHS-
funded facilities from January 1, 1987, through
December 31, 2008, in a dataset extracted May
12, 2009. For most drugs, characteristics of
clients entering with a primary problem with the
drug are discussed, but in the case of club drugs,
information is provided on any client with a
primary, secondary, or tertiary problem with that
drug. Analysis was by the author.
Information on impaired drivers entering
treatment was drawn from Maxwell, J.C. &
Freeman, J. E. (2007), Gender Differences in
DUI Offenders in Treatment in Texas Traffic
Injury Prevention, 8:353-360 and from Maxwell,
J.C., Freeman, J.E., & Davey, J.D. Too Young to
Drink but Old Enough to Drive Under the
Influence: A Study of Underage Offenders as
Seen in Substance Abuse Treatment in Texas,
Drug and Alcohol Dependence, available on line
May 27, 2008.
Information on marijuana admissions to treatment
are from Copeland, J. & Maxwell, J. C. (2007).
Cannabis treatment outcomes among legally
coerced and non-coerced adults. BioMed Central
Public Health, 7:111-118.
• Information on drug-involved deaths through
2007 came from death certificates from the
Bureau of Vital Statistics, DSHS; analysis was by
the author. Because justices of the peace, who
have no medical training, can sign death
certificates, the actual substances involved may
not be listed. Instead, a notation such as
“narcotism” may be used. The 2003 death cases
are incomplete.
Data on heroin overdose deaths in Dallas came
from Coleman, J.J. , Special Report: Cheese-
Heroin in Dallas, TX, Prescription Drug Research
Center, Fairfax, VA, 2007.
• Information on drugs identified by laboratory
tests was from the Texas Department of Public
Safety (DPS), which reported results from
toxicological analyses of substances for 1998
through December 2008 to the National Forensic
Laboratory Information System (NFLIS) of the
Drug Enforcement Administration (DEA).
Analysis was by the author on data downloaded
from NFLIS on May 14, 2009. Reports from the
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
National Clandestine Laboratory Database were
downloaded on May 23, 2008 from
http://www.usdoj.gov/dea/concern/map_lab_seiz
ures.html.
• Price, purity, trafficking, distribution, and
supply information was provided for July–
December 2008 reports on trends in trafficking
from the Dallas, El Paso, and Houston Field
Divisions of the DEA and from DEA’s Domestic
Monitor Program (DMP).
• Reports by users and street outreach workers
on drug trends for the first 3 quarters of fiscal
year (FY) 2009 were reported to DSHS by
workers at local human immunodeficiency virus
(HIV) counseling and testing programs across the
State.
• Sexually transmitted disease (STD), HIV, and
acquired immunodeficiency syndrome (AIDS)
data were provided by DSHS for annual periods
through December 2008. The HIV cases exclude
any that later seroconverted to AIDS. Data also
came from Maxwell, J.C. & Spence, R.T. , An
exploratory study of inhalers and injectors who
used black tar heroin, Journal of Maintenance in
the Addictions, 3(1), 61–81, 2006.
DRUG ABUSE PATTERNS AND TRENDS
The 2006–2007 NSDUH estimated that 6.4 percent
of the Texas population age 12 and older had used
an illicit drug in the past month, which is below the
national average of 8.0 percent, and 2.7 percent of
Texans were dependent on or abused an illicit drug in
the past year, as compared to 2.8 percent nationally.
For the period 2004–2006, 6.5 percent of the
population age 12 and older in the Dallas
metropolitan area and 6.2 percent in the Houston
area had used any illicit drug. The prevalence of drug
use by planning region is shown in appendix 2.
With the recent problems in the economy, HIV/AIDS
outreach programs have reported increases in the
numbers of people engaging in sex work to support
themselves and their families or to obtain drugs,
which is resulting in increases in sexually transmitted
diseases (STDs).
COCAINE/CRACK
Trends in cocaine use have varied over time (exhibit
1). New terms for powder cocaine include “soft”,
“snow seal,” and “her,” with new terms for crack
cocaine including “hard,” “cookie,” and “biscuit.”
2
 Exhibit 1. Texas Poison Control, Treatment Admissions, Lab
Cocaine (crack and powder together) represented 22
Exhibits, Deaths, & Purity for Cocaine: 1998-2008 percent of all admissions to DSHS-funded treatment
programs in 2008, down from 32 percent in 1995.
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Among all cocaine admissions, cocaine inhalers
10000
were the youngest and most likely to be Hispanic,
Logarithmic Scal

1000 and involved in the criminal justice or legal systems

100 (exhibit 3). Cocaine injectors were older than
10 inhalers but younger than crack smokers; they were
1 the most likely to be White. While 36 percent of the
# PCC # Treatment # DPS Lab # Deaths % Pure powder cocaine clients reported no problem with a
Calls Exhibits second substance, 30 percent reported a problem
with alcohol and 20 percent with marijuana. Of the
crack cocaine clients, 37 percent reported no second
The Texas School Survey of Substance Abuse:
substance problem, with 31 percent reporting a
Grades 7–12, 2008 reported that lifetime use of
problem with alcohol, 18 percent with marijuana, and
powder and crack cocaine had dropped from a high
5 percent with powder cocaine.
of 9 percent in 1998 to 7 percent in 2008, while past-
month use dropped from 4 percent in 1998 to 2
Exhibit 3. Characteristics of Clients Admitted to
percent in 2008. Some 6 percent of students in
TDSHS-Funded Treatment with a Primary Problem
nonborder counties had ever used powder or with Cocaine by Route of Administration: 2008
crack/cocaine, and 2 percent had used it in the past
month. In comparison, students in schools on the
Texas border reported higher levels of cocaine use— Crack Powder Powder
10 percent lifetime and 4 percent past month (exhibit Cocaine Cocaine Cocaine Cocaine
2). Smoke Inject Inhale Alla

Exhibit 2. Percentage of Border and Nonborder Texas # Admissions 10,593 940 6,899 19,247
Secondary Students Who Had Ever Used Powder or % of Cocaine Admits 55 5 36 100
Crack Cocaine, by Grade: 2008 Lag-1st Use to Tmt-Yrs. 14 16 10 13
50% Cocaine-Border Cocaine-Non-Border Average Age 39 37 31 36
45% % Male 48 56 50 50
40%
% Black 47 6 20 35
35%
% White 36 67 26 33
30%
% Hispanic 17 23 53 31
25%
% CJ Involved 47 54 62 54
20% 15% 16%
13% % Employed 15 19 36 24
15% 11% 11%
9% % Homeless 20 16 5 14
10% 6% 7%
4% 3% 4% 5% a
5% Total includes clients with "other" routes of administration.
0%
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Source: DSHS
Source: DSHS

The term “lag” (exhibit 3) refers to the period from

first consistent or regular use of a drug to the date of
The 2007 YRBS reported that 12.6 percent of Texas
admission to treatment. Powder cocaine inhalers
high school students in grades 9–12 had ever used
averaged 10 years between first regular use and
cocaine, as compared to 11.9 percent in 2005; 5.4
entrance to treatment, while injectors averaged 16
percent had used in the past month, as compared to
years of use before they entered treatment.
5.5 percent in 2005. The 2005 Texas college survey
reported that 10 percent had ever used cocaine or
Between 1987 and 2008, the percentage of Hispanic
crack, and 2 percent had used in the past month.
treatment admissions using powder cocaine
increased from 23 percent to 50 percent, while for
For the period 2006–2007, the NSDUH reported that
Whites and Blacks, the percentages dropped from
2.3 percent of the Texas population age 12 and older
48 percent to 30 percent and from 28 percent to 19
had used cocaine in the past year, below the national
percent, respectively. Exhibit 4 shows these changes
rate of 2.4 percent.
between 1993 and 2008 by route of administration.
The proportion of Blacks among crack cocaine
Texas Poison Center Network calls involving the use
admissions fell from 75 percent in 1993 to 47 percent
of cocaine increased from 497 in 1998 to 1,363 in
in 2008, while the proportion of Whites increased
2007 and then decreased to 977 in 2008 (exhibit 1).
from 20 percent in 1993 to 36 percent in 2008.
Sixty-one percent of the cases in 2008 were male.
Hispanic crack admissions rose from 5 percent to 17

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 3

percent in the same time period. in El Paso, $50–$80 in Dallas, and $60–$100 in
Houston. An ounce cost $600−$950 in Dallas, $600–
Exhibit 4. Routes of Administration of Cocaine by
$1,000 in Houston, $500-$850 in Lubbock, $400–
Race/Ethnicity from DSHS Treatment Admissions: $700 in Midland, $500 in El Paso, and $400–$500 in
1993–2008 Laredo. A kilogram of cocaine cost $17,500–$27,500
100%
in Dallas; $11,000-$22,500 in El Paso; $15,000–
90%
80%
$26,500 in Houston; $16,000–$17,000 in Laredo;
70% $12,400–$25,000 in McAllen;$21,000-$22,000 in
60% Hispanic Lubbock; and $25,000–$28,000 in San Antonio.
50%
White
40%
30%
Black
Exhibit 6. Price of a Kilogram of Cocaine in Texas as
20%
Reported by the DEA: 1987–2008
10%
(Prices reported by half year since 1993)
0%
Crack-93 Crack-08 IDU-93 IDU-08 Inhale-93 Inhale-08
$50,000

Source: DSHS $40,000

The number of deaths statewide in which cocaine $30,000

was mentioned increased from 223 in 1992 to 703 in
2007 (exhibit 5). The average age of the decedents $20,000
in 2007 was 41; 40 percent were White, 33 percent $10,000
were Hispanic, and 25 percent were Black. Seventy-
six percent were male. $-
1987 1990 1h93 2h94 1h96 2h97 1h99 2h00 1h02 2h03 1h05 2h06 1h08
Source: DEA
Exhibit 5. Age and Race/Ethnicity of Persons Dying with a Mention
of Cocaine in Texas: 1992–2007
1000 42 Across the State, a rock of crack cost $10–$50, with
900
40
$10–$20 being the most common price. An ounce of
800
700 Black
crack cocaine cost $500 in El Paso; $650–$750 in
Number of Death

38
Fort Worth; $500–$700 in Lubbock; $500 in Amarillo;
Age (Years)

600 Hispanic
500 36 $800 in Midland; $500–$1,000 in Houston; $800 in
White
400
300
34 Age Galveston; $400–$700 in San Antonio; $350–$450 in
200 32
Austin; and $500 in Waco. A kilogram in Dallas
100 ranged between $18,500 and $25,500, as compared
0 30
to $14,000 in El Paso, $24,000–$26,000 in San
Antonio, $16,000 in McAllen and Midland.
92

94

96

98

00

02

04

06
19

19

19

19

20

20

20

20

Source: DSHS

Street outreach workers reported that crack cocaine

Exhibit 1 shows that the proportion of substances is the drug of choice on the streets of Galveston and
identified as cocaine by the DPS labs is decreasing. Brazoria Counties as well as in Houston and Corpus
In 1998, cocaine accounted for 40 percent of all Christi. Use of crack cocaine was reported increasing
items examined, compared with 32 percent in 2008. in parts of Austin. Lubbock reported cocaine was
cheap and very potent, and inhaling cocaine was
The Dallas DEA Field Division (FD) reported increasing in the Beaumont area.
decreased availability of cocaine between July and
December, 2008. The purity of seized cocaine ALCOHOL
decreased from 69 percent in FY 2006 and 70
percent in FY 2007 to 45 percent for the second half Alcohol is the primary drug of abuse in Texas. In
of FY 2008. The El Paso FD reported a temporary 2008, 63 percent of Texas secondary school students
moratorium on cocaine smuggling in Cuidad Juarez. (grades 7–12) had ever used alcohol, and 30 percent
Reluctance of Colombian sources to provide cocaine had drunk alcohol in the last month. Lifetime use
shipments on consignment to Mexican traffickers decreased by 5 percent and past-month use
resulted in a decreased supply in west Texas in the decreased by 3 percent between 2006 and 2008. Of
last half of 2008. The Houston DEA FD reported the particular concern is heavy consumption of alcohol,
price of a kilogram of cocaine continued to increase or binge drinking, which is defined as drinking five or
and cocaine was less available and more expensive more drinks at one time. In 2008, 12 percent of all
in San Antonio. secondary students said that when they drank, they
usually drank five or more beers at one time, and 13
Cocaine continued to be available across the State percent reported binge drinking of liquor, which has
(exhibit 6). A gram of powder cocaine cost $50–$60 remained relatively stable since 1992 (exhibit 7).

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 4

Among students in grades 4–6 in 2008, 23 percent
had ever drunk alcohol, and 15 percent had drunk
alcohol in the past school year. Lifetime use of
alcohol increased 4 percent and past-year use
increased 12 percent between 2006 and 2008.
Eleven percent of fourth graders had used alcohol in
the school year, compared with 21 percent of sixth
graders.
Exhibit 7. Percentage of Texas Secondary Students Who
Reported They Normally Consumed Five or More Drinks at One
Time, by Specific Alcoholic Beverage: 1988–2008
25%
20%
15%
Beer
10% Liquor
5%
0%
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Source: DSHS
The 2007 YRBS reported 78 percent of Texas high
school students in grades 9–12 had ever drunk
alcohol, 48 percent had drunk in the past month, and
29 percent had drunk five or more drinks in a row in
the last month. In 2005, 26 percent of girls and 33
percent of boys reported binge drinking as compared
to 28 percent of girls and 30 percent of boys
reporting binge drinking behavior in 2007.
The 2005 Texas college survey found that 84
percent had drunk alcohol in their lifetime, and 66
percent had drunk in the past month. Almost 30
percent of college students reported binge drinking
(38 percent males and 23 percent females).
Although the legal drinking age is 21, 58 percent of
college students age 18 to 20 reported drinking an
alcoholic beverage in the past month.
The 2006–2007 NSDUH estimated that 47.6 percent
of all Texans age 12 and older had drunk alcohol in
the past month, below the national average of 51.0
percent; 22.8 percent had drunk five or more drinks
on at least one day (binge drinking) in the past
month, below the national average of 23.2 percent.
Among underage Texas drinkers (age 12 to 20), 25
percent reported past-month alcohol use, as
compared to 28.1 percent nationally, and 16.3
percent of Texas underage youths reported past-
month binge drinking, as compared to 18.8 percent
nationally. The highest rate of binge drinking was in
Region 1, and the lowest rate was in Region 4.
Region 10 had the highest proportion of the Texas
population who thought there was great risk in
drinking five or more drinks once or twice a week,
while Region 7 had the lowest perception of great
risk (appendix 2).
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
In 2008, 27 percent of all clients admitted to publicly-
funded treatment programs had a primary problem
with alcohol (appendix 1). The characteristics of
alcohol admissions have changed over the years. In
1988, 82 percent of the clients were male, compared
with 70 percent in 2008. The proportion of White
clients declined from 63 percent in 1988 to 56
percent in 2008, and the proportion of Hispanic
clients increased from 28 to 30 percent. The
proportion of Black clients increased from 7 to 12
percent. The average age increased from 33 to 38
years. Alcohol clients are becoming more likely to be
polydrug users: the proportion reporting no
secondary drug problem dropped from 67 to 52
percent, and the proportion with a problem with
cocaine (powder or crack) increased from 7 to 23
percent. Consuming cocaine and alcohol at the
same time produces cocaethylene, which intensifies
cocaine's euphoric effects.
The characteristics of persons who entered treatment
with a past-year offense for Driving Under the
Influence (DUI) have changed over time. Between
1990 and 2008, the proportion of past-year DUI
arrestees who went to DSHS-funded treatment who
were female increased from 13 percent to 29 percent
in 2008, and the proportion of DUI treatment
admissions who had a primary problem with alcohol
decreased from 88 to 67 percent. Of those DUI
arrestees under the legal drinking age of 21 who
entered treatment, the proportion reporting a primary
problem with alcohol decreased from 75 percent in
1990 to 21 percent in 2008, the proportion with a
primary problem of marijuana increased from 19 to
63 percent, and the proportion with a primary
problem with cocaine increased from 5 to 7 percent.
HEROIN
Exhibit 8. Texas Poison Control Calls, Treatment Admissions,
DPS Lab Exhibits, and Deaths for Heroin: 1998-2008
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
1000
Logarithmic Scale
100
10
1
# PCC Calls # Treatment # DPS Labs # Deaths
Ex hibits
The proportion of Texas secondary students
reporting lifetime use of heroin dropped from 2.4
percent in 1998 to 1.4 percent in 2008. The 2007
YRBS found 2.4 percent of Texas high school
students had ever used heroin, as compared to a
5
national median of 4 percent. Dallas and Houston
students reported lifetime use of heroin at
approximately 5 percent, as compared to a median
of 3 percent among other local school districts that
participated across the Nation. The 2005 college
survey found 5 percent of students had ever used
heroin or other opiates. The 2004–2006 NSDUH
reported 0.1 percent of Texans age 12 and older had
used heroin in the past year.
Calls to the Texas Poison Center Network involving
confirmed exposures to heroin ranged from 181 in
1998 to a high of 296 in 2000 but dropped to 192 in
2008 (exhibit 8).
Heroin was the primary drug of abuse for 11 percent
of clients admitted to treatment in 2008 (appendix 1).
The characteristics of these addicts vary by route of
administration, as exhibit 9 illustrates. Most heroin
addicts entering treatment inject the drug, but the
proportion inhaling heroin increased from 4 percent
of all heroin admissions in 1996 to 20 percent in
age of all heroin admissions has decreased from 37
in 1996 to 33 in 2008. This increase in inhalers and
decrease in age at admission is evidence of the
emergence of younger cohort of heroin users. The
proportion of all treatment clients with a primary
problem with heroin who are Hispanic increased
from 23 percent in 1996 to 56 percent in 2008
(exhibit 10).
Exhibit 10. Percent of Heroin Admissions to DSHS-
Funded Treatment by Race/Ethnicity: 1986–2008
100%
80%
60%
40%
20%
0%

86

88

90

92

94

96

98

00

02

04

06

08
2008. During that time, the proportion of inhalers
Source: DSHS
who were Hispanic increased from 26 to 64 percent, Black White Hispanic
and the average age of inhalers decreased from 30
to 27 years.
Of all the 2008 heroin admissions, 45 percent
Exhibit 9. Characteristics of Clients Admitted to
reported no second substance problem and 20
DSHS-Funded Treatment with a Primary Problem percent reported a problem with powder cocaine
with Heroin by Route of Administration: 2008 (which shows the tendency to "speedball," or use
heroin and cocaine sequentially). Nine percent
reported a second problem with marijuana, 8 percent
Inject Inhale Smoke Alla
with alcohol, 6 percent with other opiates, and 5
# Admissions 7,583 2,023 80 9,945
percent with crack cocaine.
% of Heroin Admits 76 20 1 100
Lag-1st Use to Tmt-Yrs. 14 7 9 12
"Cheese heroin," a mixture of Tylenol PM® and
Average Age 35 27 30 33
heroin (heroin combined with diphenhydramine and
% Male 64 56 66 64
acetaminophen), continues to be a problem in Dallas,
% Black 6 14 5 8
and heroin inhaling is increasing across the State.
% White 38 21 53 35
Diphenhydramine has traditionally been used as a
% Hispanic 54 64 40 56
% CJ Involved 29 39 41 32
“cut” to turn tar into powder. A 2007 analysis of
% Employed 12 23 33 15
records from the Dallas County Medical Examiner
% Homeless 15 8 6 13
found that only one death involved just "cheese
a heroin." All the other "cheese heroin" deaths also
Total includes clients with other routes of administration.
involved combinations of cocaine, alprazolam,
Source: DSHS
hydrocodone, etc., which shows that this is not a
population of novice users but is a growing problem
among young experienced heroin users (Coleman,
While the number of individuals who inhale heroin
2007).
was small, the lag period between first use and
seeking treatment for this group was 7 years,
Cases of "cheese heroin" were reported in other
compared with 14 years for injectors. This shorter lag
counties in the Dallas/Fort Worth area, but the term
period means that, contrary to the street rumors that
"cheese heroin" is rarely reported elsewhere in the
“sniffing or inhaling is not addictive,” inhalers can
State, although heroin use by teenagers and persons
become dependent on heroin. They will either enter
in their twenties continued to increase statewide. The
treatment sooner while still inhaling, or they will shift
number of clients statewide under age 30 entering
to injecting, thus increasing their risk of hepatitis C
treatment with a primary problem with heroin
and HIV infection, becoming more impaired, and
increased from 3,118 in 2005 to 4,630 in 2008. Fifty-
entering treatment later.
seven percent of the teenage clients were male and
85 percent were Hispanic. Sixty-two percent were
In addition to the decrease in the age of inhalers, the

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 6

heroin inhalers, but as age increased, users shifted
route of administration, with 74 percent of clients in
their twenties reporting injecting the drug.
In 2007, there were 390 deaths in Texas in which the
death certificate included a mention of heroin,
narcotics, opiates, or morphine (terms used by
justices of the peace were not always as specific as
desired) (exhibit 11). Fifty-four percent were White,
38 percent were Hispanic, and 7 percent were Black,
76 percent were male. The average age was 37,
down from 39 in 2007, which is another indication of
a younger heroin-using population.
Exhibit 11. Age and Race/Ethnicity of Persons Dying with a
Mention of Heroin in Texas: 1992–2007
100%
80%
Percent by Race
60%
15
40%
20%
0%
1992 1995 1998 2001
Source: DSHS
Exhibit 8 shows that the proportion of items identified
as heroin by DPS labs has remained low at 1–2
percent over the years. The predominant form of
heroin in Texas is black tar, which has a dark,
gummy, oily texture that can be diluted with water
and injected. Exhibit 12 shows the decline in price
over the years. Depending on the location, black tar
heroin sold on the street for $5–$20 per paper,
balloon, or capsule; $100–$300 per gram; $800–
$4,000 per ounce; and $25,000–$62,000 per
kilogram. An ounce of black tar cost $1,000 in El
Paso; $3,600–$4,000 in Midland; $1,000–$2,500 in
Houston; $1,300 in Galveston; $1,300 in Laredo;
$1,000 in McAllen; $1,200–$1,600 in Austin; $800–
$1,300 in Fort Worth; $1,000 in Lubbock; and
$1,200–$2,400 in San Antonio. Black tar heroin cost
$35,000–$50,000 per kilogram in Dallas; $25,000 in
El Paso; $40,000–$50,000 in Houston; $25,000–
$40,000 in McAllen; and $50,000–$62,000 in San
Antonio.
Mexican brown heroin, which is black tar heroin that
has been cut with lactose, diphenhydramine, or
another substance and then turned into a powder to
inject or inhale, cost $10 per cap and $110–$250 per
gram. An ounce cost $500–$800 in San Antonio;
$800 in McAllen; $800-$1,600 in Dallas; and $3,400-
$4,000 in Lubbock.
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
Colombian heroin sold for $60–$80 per gram and
$1,200 per ounce in McAllen and $2,000 in Dallas. It
sold for $50,000–$80,000 per kilogram in Houston;
$30,000 in McAllen; $84,000–$90,000 in El Paso;
and $65,000–$80,000 in Dallas.
Colombian heroin sold for $60–$80 per gram and
$1,200 per ounce in McAllen and $2,000 in Dallas. It
sold for $50,000–$80,000 per kilogram in Houston;
$30,000 in McAllen; $84,000–$90,000 in El Paso;
and $65,000–$80,000 in Dallas.
Southwest and Southeast Asian heroin sold for
$200–$350 per gram, $2,000–$4,000 per ounce, and
$70,000 per kilogram in Dallas.
Exhibit 12. Price of an Ounce of Mexican Black Tar Heroin in Texas as
40 Reported by the DEA: 1987–2008
39.5 (Prices reported by half year since 1993)
39
$9,000
38.5 Black
Age (Years)
$8,000
38 Hispanic
$7,000
37.5 White
$6,000
37
Age $5,000
36.5
36 $4,000
35.5 $3,000
$2,000
2004 2007
$1,000
$-
1987 1990 1h93 2h94 1h96 2h97 1h99 2h00 1h02 2h03 1h05 2h06 1h08
Source: DEA
The Houston Police Department reported an
increase in the availability of heroin on the street,
and the Galveston DEA Regional Office reported
black tar was more readily available than in previous
quarters. Heroin prices in McAllen were stable. In the
second quarter of 2009, the Houston DEA FD
reported Mexican nationals and Mexican Americans
and Blacks dominated the heroin trade, with a few
Nigerians also involved in heroin trafficking. Blacks
from Louisiana were trafficking quantities of
Colombian heroin. Black tar was more prevalent in
the north areas of Houston, while Colombian white
heroin was more prevalent in the southwest areas of
Houston.
Exhibit 13 shows the purity and price of heroin
purchased by the DEA in four Texas cities under the
DMP. Heroin is much purer at the border in El Paso
and decreases in purity as it moves north, since it is
“cut” with other products as it passes through the
chain of dealers. Street outreach workers reported an
increase in black tar heroin in areas of Corpus
Christi. Lubbock outreach workers reported heroin
was not as pure as in the past and it was being “cut”
with alprazolam and there were mentions of cheese
heroin.
7
Exhibit 13. Price and Purity of Heroin Purchased in Dallas, El Paso, Houston, and San Antonio by the DEA: 1995–2007

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Dallas Purity (%) 6.8 3.5 7.0 11.8 14.0 16.0 13.4 17.2 13.3 16.3 11.6 17.7 20.6
Price/Milligram Pure $2.34 $6.66 $4.16 $1.06 $1.01 $0.69 $1.36 $0.75 $0.98 $0.90 $1.11 $1.10 $1.09
El Paso Purity (%) 56.7 50.8 41.8 40.3 44.7 50.5 44.7 44.8 39.8
Price/Milligram Pure $0.49 $0.34 $0.44 $0.27 $0.40 $0.27 $0.40 $0.33 $0.49
Houston Purity (%) 16.0 26.1 16.3 34.8 17.4 18.2 11.3 28.2 27.4 24.8 24.4 18.1 7.0
Price/Milligram Pure $1.36 $2.15 $2.20 $2.43 $1.24 $1.14 $1.51 $0.64 $0.45 $0.44 $1.11 $1.90 $1.66
San Antonio Purity (%) 8.2 6.4 11.2 17.4 7.1
Price/Milligram Pure $1.97 $2.24 $0.56 $0.79 $1.88

Source: DEA

Exhibit 14. Hydrocodone, Oxycodone, Methadone, and Fentanyl Indicators in Texas: 1998–2008

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Poison Control Center Cases of Abuse and Misuse
Fentanyl 9 2 3 11 17 10 36 28 31
Hydrocodone 192 264 286 339 429 414 516 505 657 703 723
Methadone 17 15 30 27 50 41 69 69 73 91 217
Oxycodone 12 26 22 34 68 64 77 50 68 67 81
DSHS Treatment Admissions
Methadone 55 69 44 52 75 86 63 91 101 113 160
"Other Opiates"a 553 815 890 1,386 2084 2794 3433 3482 3903 4529 5221
Deaths with Mention of Substance (DSHS)
Fentanyl 8 5 4 7 22 10 32 30 43 49
Hydrocodone 5 25 52 107 168 140 201 269 400 360
Methadone 31 32 62 90 131 122 164 201 245 195
Oxycodone 1 8 20 40 56 60 66 62 81 65
Drug Exhibits Identified by DPS Laboratories
Fentanyl 0 3 1 7 4 2 14 7 14 10 10
Hydrocodone 52 479 629 771 747 1212 1598 1789 2324 2812 2177
Methadone 1 19 22 42 58 70 130 133 169 209 181
Oxycodone 10 36 72 115 106 174 270 237 264 244 258

a
"Other Opiates" refers to those other than heroin.

OTHER OPIATES The proportion of deaths involving only methadone or

methadone plus alcohol has decreased from 58
The “other opiates” group excludes heroin but percent of all methadone deaths in 1992 to 39
includes opiates such as methadone, codeine, percent in 2007, while those involving combinations
hydrocodone (Vicodin®, Tussionex®), oxycodone with illicit drugs decreased from 25 to 15 percent, and
(OxyContin®, Percodan®, Percocet-5®, Tylox®), those involving combinations with prescription or licit
buprenorphine (Suboxone® and Subutex®), d- drugs increased from 17 to 46 percent. The number
propoxyphene (Darvon®), hydromorphone involving overdose deaths of clients in narcotic
(Dilaudid®), morphine, meperidine (Demerol®), and treatment programs has remained level, at 11 of all
opium. the methadone deaths in 1993 and 11 in 2007.

The 2008 Texas secondary school survey queried Six percent of all clients who entered publicly-funded
about use of other opiates “to get high”, and reported treatment during 2008 used opiates other than
that 2.0 percent had ever used hydrocodone, 1.8 heroin. Of these, 160 used illegal methadone and
percent reported ever having drunk codeine cough 5,221 used other opiate drugs (exhibit 14). Those
syrup, and 1.1 percent had ever used oxycodone in who reported a primary problem with other opiates
that manner. differed from those who reported a problem with
heroin. They were much more likely to be female (58
The 2006–2007 NSDUH reported that 4.7 percent of percent), to be White (77 percent), to have sought
Texans age 12 and older had used pain relievers help in an emergency department (45 percent), and
nonmedically in the past year (as compared to 5.1 to report more health and psychological or emotional
percent nationally). Region 7 reported the highest problems in the month prior to entering treatment
level of past-year nonmedical use of pain relievers in (appendix 1). Forty-five percent of these clients with
2004-2006, and Region 6 had the lowest levels of problems with other opiates also reported problems
use (appendix 2). with other substances such as sedatives (14
percent) and alcohol (12 percent). The clients with

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 8

problems with illicit methadone were also more likely MARIJUANA
than heroin admissions to be female (54 percent)
and 79 percent were White and 12 percent were
Exhibit 15. Texas Poison Control Calls, Treatment Admissions, &
Hispanic. Only 24 percent had no second drug DPS Lab Exhibits for Cannabis: 1998-2008
problem, and of those who did have other problems,
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
13 percent had problems with alcohol, 26 percent
with other opiates, 13 percent with sedatives, and 11 1000

Logarithmic Scale
percent with heroin.
100

Persons who died from one of the other opiates were 10

more likely to be White and to be older than those
persons whose death certificates mentioned heroin. 1

Of the 360 deaths with a mention of hydrocodone in # PCC Calls # Treatment # DPS Lab Exhhibits
2007, 54 percent were male, 78 percent were White,
9 percent were Black, 13 percent were Hispanic, and
New slang terms for marijuana include “Bud,” “Kill,”
the average age was 41. Of the 65 deaths in 2007
and “Carpet.”
with a mention of oxycodone, 63 percent were male,
73 percent were White, 8 percent were Black, 1
Marijuana indicators have varied over the years
percent was Hispanic, and the average age was 41.
(exhibit 15). Among Texas students in 2008 in
There were 48 deaths with a mention of fentanyl in
grades 4–6, 1.7 percent had ever used marijuana,
2007. Of these, 62 percent were male, 89 percent
with 1.2 percent reporting use in the past school
were White, 8 percent were Hispanic, and the
year. Among Texas secondary students (grades 7–
average age was 42. Of the 195 deaths with a
12), 25 percent had ever tried marijuana, and 10
mention of methadone, 62 percent were male, 87
percent had used in the past month. From 2006 to
percent were White, 2 percent were Black, 6 percent
2008, this amounted to a 7 percent decrease in
were Hispanic, and the average age was 42.
lifetime use and a 9 percent decrease in past-month
use. Past-month use shown by grade level is shown
In the Dallas DEA FD, hydrocodone, alprazolam, and
in exhibit 16. The 2008 survey found that of those
promethazine with codeine are the most commonly
youths who used marijuana, 66 percent smoked
diverted drugs. Other popular drugs are carisoprodol,
“blunts” at least one-half of the time, as compared to
diazepam, Adderall®, methadone, and oxycodone.
58 percent who smoked “joints” at least one-half of
Houston DEA FD reports hydrocodone is one of the
the time. The relationship between tobacco use,
most commonly abused drugs and codeine cough
marijuana use, and cigars was also seen in the
syrup continues to be abused, but not as widely as in
finding that of those youths who had ever used
the past. The El Paso DEA FD reported morphine,
tobacco and never used marijuana, 2.5 percent had
Demerol®, oxycodone, and hydrocodone were the
ever used cigars. In comparison, of those who had
leading causes of drug poisoning deaths in El Paso.
ever used tobacco and ever used marijuana, 72
percent had ever used cigars.
Promethazine or phenergan cough syrup with
codeine sold for $200–$400 per pint in Dallas and
$300-$400 in Houston. Hydrocodone sold for $5–$10 Exhibit 16. Percentage of Texas Secondary Students Who Had Used
Marijuana in the Past Month, by Grade: 1988–2008
per pill in Dallas and $2–$4 in Houston, and 20%
OxyContin® cost $20 per pill in Dallas and $20–$50 Grade 7

in Waco. In Tyler, OxyContin® sold for $8–$20 for a 15% Grade 8

20 milligram tablet, $6–$10 for a 40 milligram tablet, Grade 9

and $35 for an 80 milligram tablet. Dilaudid® sold for 10% Grade 10

Grade 11
$20–$40 in Dallas, and methadone cost $7–$10 per
5% Grade 12
tablet in Fort Worth.
0%
DPS labs reported decreases in the number of 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

exhibits of hydrocodone and methadone in 2008, Source: DSHS

while the number of fentanyl exhibits has varied over

the years (exhibit 14).
Street outreach workers in Brazoria County reported
“doctor hopping” occurring, with pain clinics being
sources of opioid medications. In Beaumont, there
was increasing use of codeine and promethazine
syrup diluted in sodas.
In 2007, the YRBS reported that 38 percent of Texas
high school students in grades 9–12 had ever
smoked marijuana, a significant decrease from 42
percent in 2005. Past-month use declined from 22
percent in 2005 to 19 percent in 2007. The 2005
Texas college survey reported that 37 percent of
students had ever used marijuana, and 11 percent
had used in the past month. The 2006–2007 NSDUH

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 9

estimated that 7.9 percent of Texans age 12 and
older had used marijuana in the past year (compared
to 10.2 percent nationally), with 4.3 percent using in
the past month (compared to 5.9 percent nationally).
Region 7 reported the highest level of past-year use
of marijuana and Region 10 had the lowest level
(appendix 2).
The Texas Poison Center Network reported there
were 133 calls confirming exposure to marijuana in
1998, compared with 544 in 2006 and 502 in 2008
(exhibit 15).
Marijuana was the primary problem for 23 percent of
admissions to treatment programs in 2008 (appendix
1) and while 45 percent reported no second
substance abuse problem, 28 percent had a problem
with alcohol, and 11 percent had a problem with
powder cocaine. The average age was 24.
Approximately 42 percent were Hispanic, 29 percent
were White, and 28 percent were Black. Eighty-one
percent had legal problems or had been referred from
the criminal justice system. Those who were referred
from the criminal justice system were more likely to
complete treatment, compared with noncoerced
clients. Referred clients were more likely to have
received less intensive forms of treatment and to
have not used marijuana in the month prior to 90-day
post-discharge follow-up. This study concluded that
more public health information is needed on
marijuana dependence and there is a need for
increased availability of early and brief interventions
in a variety of primary health care settings to reduce
the late presentations of the more severely impaired
voluntary clients (Copeland & Maxwell, 2007).
marijuana trafficking organizations in the Houston
area were Mexican, but there was a growing trend of
Vietnamese and Canadian trafficking organizations
distributing marijuana in the area. In the Dallas/Fort
Worth area, "Popcorn" marijuana was available at
$850 per pound. This variety is often grown in
Chihuahua in shade under pine trees and it is mostly
buds and is slightly greasy or oily to the touch.
Hydroponic marijuana sold for $4,600 per pound in
Galveston; $3,000–$4,500 in Austin; $2,500–$6,000
in Dallas; and $3,000–$5,000 in San Antonio. The
average price for a pound of commercial grade
marijuana was $140–$160 in Laredo; $85–$180 in
McAllen; $330–$450 in San Antonio; $280 in
Houston; $200 in El Paso; $500–$600 in Lubbock;
$375–$600 in Midland; $250–$650 in Alpine; and
$300–$800 in Dallas. Sinsemilla sold for $750–
$1,200 per pound in the Dallas/Fort Worth area,
$300–$500 in Houston, and $600 in Galveston.
Outreach workers in Dallas reported increased
marijuana use among the homeless. And Houston
workers reported youths in middle schools were
entering outpatient treatment due to their problems
with marijuana.
STIMULANTS
Exhibit 18. Texas Poison Control Calls, Treatment Admissions, Deaths,
Lab Exhibits, and Purity of Methamphetamine: 1998-2008
1000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
100
Logarithmic Scale

Exhibit 17 . Price of a Pound of Commercial Grade Marijuana

in Texas as Reported by the DEA: 1992–2008
10
$1,800
$1,600
$1,400
$1,200 1

$1,000 # PCC Calls % Tmt Admits # Deaths % of DPS Exhibits % Purity

$800
$600
$400
Amphetamine-type substances come in different
$200 forms and with different names. “Speed” (“meth,”
$- “crank”) is a powdered methamphetamine of
relatively low purity and is sold in grams or ounces. It
92

94

96

98

00

02

04

06

08

can be snorted or injected. “Pills” can be

19

19

19

19

20

20

20

20

20

Source: DEA
Marijuana was identified in 33 percent of all the
exhibits analyzed by DPS laboratories in 2000, but in
only 26 percent in 2008 (exhibit 15) and exhibit 17
shows the decline in the price of a pound of
marijuana since 1992.
The Houston DEA FD reported increases in indoor
hydroponic grow houses in Houston; marijuana
prices and quantities were stable in San Antonio and
McAllen. The Houston FD reported the majority of
pharmaceutical grade stimulants such as dextro-
amphetamine, Dexedrine®, Adderall®, Concerta®,
Vyvanse®, Ritalin® (methylphenidate), or
phentermine, or they can be methamphetamine
powder that has been pressed into tablets and sold
as amphetamines, “Yaba,” or ecstasy. Stimulant pills
can be taken orally, crushed for inhalation, or
dissolved in water for injection.
There is also a damp, sticky methamphetamine

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 10

powder of higher purity than speed that is known as (62 percent readmissions) than amphetamine pill
“Base” in Australia and “Peanut Butter” in parts of the takers (48 percent), ice smokers, or inhalers (both at
United States. “Ice,” also known as “crystal” or “Tina,” 45 percent).
is methamphetamine that has been “washed” in a
solvent to remove impurities; it has longer-lasting Exhibit 19. Characteristics of Clients Admitted to DSHS-Funded
physical effects and purity levels above 80 percent. Treatment with a Primary Problem of Amphetamines or
Ice can be smoked in a glass pipe, “chased” on Methamphetamines by Route of Administration: 2008
aluminum foil, mixed with marijuana and smoked
through a “bong,” or injected. Alla
Smoke Inject Inhale Oral
# Admissions 3,680 2,470 682 332 7,458
The Texas secondary school survey reported that
% of Stimulant Admits 49 33 9 4 100
lifetime use of stimulants, or “uppers,” was 5 percent,
Lag-1st Use to Tmt-Yrs. 10 15 11 13 12
and past-month use was 2 percent in 2008. Two
percent responded positively to a separate question Average Age-Yrs. 32 34 34 35 33
regarding lifetime use of methamphetamine, and 1 % Male 42 47 46 45 45
percent reported past-month use. The 2007 YRBS % Black 2 1 2 9 2
reported lifetime use of methamphetamine by Texas % White 81 93 81 79 85
high school students was 6.7 percent. The 2005 % Hispanic 15 5 15 9 11
Texas college survey reported that 10 percent had % CJ Involved 67 64 72 69 68
ever used stimulants and 2 percent had used in the % Employed 32 22 35 32 29
past month. The 2004–2006 NSDUH reported that % Homeless 7 11 3 7 8
past-year nonmedical use of stimulants (which a
Total includes clients with "other" routes of administration
included amphetamines, methamphetamine,
methylphenidate, and prescription diet pills) in Texas Source: DSHS
was 1.4 percent, and past-year use of meth-
amphetamine was 0.7 percent. Exhibit 20. Route of Administration of Methamphetamine by
Clients Admitted to DSHS-Funded Programs: 1988–2008
As exhibit 18 shows, all methamphetamine indicators
have decreased since 2005 when the precursor
100
regulations were implemented. There were 144 calls
to Texas poison control centers involving exposure to 80
Smoking
methamphetamine in 1998; 336 in 2006; 315 in 2007; 60
Percent

and 298 in 2008 (exhibit 18). Of the 2008 calls, 104
were for Adderall®; 77 for methamphetamine or
speed; 28 for amphetamine; 72 for Vyvanse®; 21 for
Concerta®; 19 for Ritalin®; and 6 for phentermine.
Methamphetamine/amphetamine admissions to treat-
ment programs increased from 5 percent of all
admissions in 2000 to 11 percent in 2007 and
dropped to 8 percent in 2008.
The average age of clients admitted for a primary
problem with stimulants increased from 26 in 1985 to
33 in 2008 (exhibit 19). The proportion of White
clients rose from 80 percent in 1985 to 85 percent in
2008, while the proportion of Hispanics remained at
11 percent, and the proportion of Blacks dropped
from 9 percent to 2 percent. Unlike the other drug
categories, more than one-half of the clients entering
treatment were women (55 percent). Clients with a
primary problem with methamphetamine reported
secondary problems with marijuana (24 percent),
alcohol (16 percent), and powder cocaine (8
percent); 41 percent reported no secondary
substance abuse problem.
Users of amphetamines or methamphetamine tend
to differ depending on their route of administration,
as exhibit 19 shows. Methamphetamine injectors
were more likely to have been in treatment before
Inhaling
40
Injecting
20
0
1988 1991 1994 1997 2000 2003 2006
SOURCE: DSHS
In 2008, more clients smoked ice than injected speed
(exhibit 20). The proportion smoking ice increased
from less than 1 percent in 1988 to 53 percent in 2007
but dropped to 49 percent in 2008. The percentage of
clients injecting the drug dropped from 84 percent in
1988 to 33 percent in 2008.
Statewide, there were 17 deaths in which ampheta-
mines or methamphetamines were mentioned in
1998, compared with 177 in 2005, 116 in 2006, and
106 in 2007 (exhibit 18). Of the decedents in 2007,
76 percent were male, 73 percent were White, 22
percent were Hispanic, 4 percent were Black, and
the average age was 40.
Methamphetamine and amphetamine together repre-
sented 16 percent of all items examined by DPS
laboratories in 2000 and reached a peak of 25 percent
in 2005 before dropping to 16 percent in 2008 (exhibit
18). Sixteen percent of the exhibits in 2008 were

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 11

methamphetamine, and 0.5 percent was
amphetamine.
The National Clandestine Laboratory Database
reported that 1,773 methamphetamine laboratories
were seized in Texas in 1999; 429 in 2000; 619 in
2001; 547 in 2002; 677 in 2003; 452 in 2004; 270 in
2005; 132 in 2006; 79 in 2007; and 112 in 2008.
A pound of powder methamphetamine sold for
$6,000–$7,500 in Laredo. A pound of ice sold for
$12,000–$21,000 in Houston; $20,000–$25,000 in
San Antonio; $6,000–$7,500 in Laredo; and
$20,000–$27,000 in Dallas. An ounce of ice sold for
$375–$1,000 in Houston and $1,000 in Waco.
Statewide, the purity of methamphetamine dropped
from 56 percent in 2004 to 33 percent in 2008
because it is being cut with methylsulfonylmethane
(MSM). MSM is available in 5-gallon quantities at local
feed stores, and it is added to the ice and heated. In
Tulsa, MSM cost $17.95 per pound. The mixture of ice
and MSM is spread out to dry like peanut brittle and
then crushed up to look like a pure ice mixture. Pure
methamphetamine from Mexico, which typically sold
for $18,000–$20,000 per pound, sold for $18,500 per
pound when “cut” with MSM. The typical first cut of a
pound of methamphetamine with MSM can yield two
pounds of medium-purity methamphetamine that
retains the same crystalline appearance.
Although Texas law requires purchasers of
pseudoephedrine products to register when they buy
the product, the registries are not computerized.
Some methamphetamine organizations are returning
to "smurfing" to obtain pseudoephedrine by paying
hourly wages to people to purchase the product from
every available outlet. The Dallas FD reports more
local clandestine laboratories have been
encountered. In Tyler, a case of 60 milligram, 120-
count pseudoephedrine pills sold for $28 per bottle,
and in Dallas a case sold for $2,400. Red
phosphorus, which is used in making
methamphetamine, sold for $100 per ounce. A new
method of producing methamphetamine was
reported. In the “one pot” or “shake and bake”
method, all the necessary chemicals are placed in a
single container such as a 2-liter soda bottle or
Coleman fuel can. The container is turned upside
down or shaken to start the chemical reaction. Some
recipes use dry ammonia nitrite and cough syrup
rather than liquid anhydrous ammonia and
pseudoephedrine pills. DEA expects this method to
spread because of the ease of production and small
amount of space required.
The Dallas DEA FD reported that the availability of
methamphetamine and ice had declined, with the
price rising because of tighter border security and
increasing difficulty in obtaining precursor chemicals
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
in Mexico. The price of a pound of
methamphetamine increased in Dallas from $4,500–
$18,000 in 2005 to $20,000–$27,000 in 2008.
The Houston DEA FD reported the price of a pound
of methamphetamine increased from $8,000–
$17,500 to $12,000–$21,000 between 2005 and
2008. In the past, most of the methamphetamine
was produced in Mexico and most of it was ice.
There has been a significant rise in
methamphetamine production in the Waco area, with
labs producing gram to ounce quantities per
production. The majority use anhydrous ammonia.
There is a small increase in the diversion of
pseudoephedrine-based medications in the San
Antonio area, as well as reports of a few small labs
in the Houston and Galveston areas. Galveston
reports an increase in the number of Hispanic users
and wholesale distributors.
The El Paso FD reported that Mexico and California
were the primary sources of methamphetamine, with
the drug transiting through El Paso to other places in
the United States.
Street outreach workers in Houston, Lufkin, and
Huntsville reported methamphetamine was continuing
to be abused in those areas.
DEPRESSANTS
Exhibit 21. Benzodiazepines as Percent of All Items Identified by DPS
Labs in Texas: 1998–2008
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Alprazolam Diazepam Clonazepam
Source: NFLIS
The depressant category includes three groups of
drugs: barbiturates, such as phenobarbital and
secobarbital (Seconal®); nonbarbiturate sedatives,
such as methaqualone, over-the-counter sleeping
aids, chloral hydrate, and tranquilizers; and
benzodiazepines, such as diazepam (Valium®),
alprazolam (Xanax®), flunitrazepam (Rohypnol®),
clonazepam (Klonopin® or Rivotril®), flurazepam
(Dalmane®), lorazepam (Ativan®), and chlor-
diazepoxide (Librium® and Librax®). Rohypnol® is
discussed separately in the Club Drugs section of this
report.
The 2008 Texas secondary school survey reported
12
lifetime use of downers was 6 percent, and past-
month use was 2 percent. Four percent had ever
used alprazolam and 1 percent had ever used
diazepam. The 2005 Texas college survey reported
9 percent had ever used sedatives, and 2 percent
had used them in the past month. The 2004–2006
NSDUH reported 0.2 percent of Texans age 12 and
older had used sedatives in the past year.
About 1.6 percent of the clients entering DSHS-
funded treatment in 2008 had a primary problem with
barbiturates, sedatives, or tranquilizers (appendix 1).
Sixty-four percent of these clients were female, and
68 percent were White, 15 percent were Hispanic,
and 13 percent were Black. They were users of
multiple drugs: only 28 percent reported no other
problem substance, as compared to 44 percent of
users of all other drugs. Of the "downer" clients, 20
percent reported a secondary problem with
marijuana, 18 percent with alcohol, 14 percent with
other opiate drugs, and 8 percent with powder
cocaine.
In 2007, there were 300 death certificates in which
alprazolam was mentioned, as compared to 215 in
2006.
Alprazolam, clonazepam, and diazepam were
among the 12 most commonly identified substances
according to the 2008 DPS lab report, although none
of them represent more than 5 percent of all items
examined in a year (exhibit 21).
Alprazolam tablets sold for $5 in San Antonio, $2–$3
in Houston, $3–$5 in Fort Worth, and $5 in Dallas.
In the Dallas area, alprazolam was used to cut black
tar heroin to produce brown heroin, and there were
reports that the alprazolam was originating in
Mexico. Houston DEA reports benzodiazepines are
among the most commonly abused drugs. The
McAllen DEA office reports most of the prescription
drugs abused at “pharming parties” come from
Medicaid fraud and from Mexican pharmacies
catering to senior citizens and uninsured United
States residents.
CLUB DRUGS AND HALLUCINOGENS
Exhibit 22 shows the demographic characteristics of
clients entering DSHS-funded treatment programs
statewide with a problem with a club drug. The row
“Primary Drug=Club Drug” shows the percentage of
clients citing a primary problem with the club drug
shown at the top of the column. The rows under the
heading “Other Primary Drug” show the percentage
of clients who had a primary problem with another
drug, such as marijuana, but who had a secondary or
tertiary problem with one of the club drugs shown at
the top of the table. Note that the treatment data
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
include a broader category, “Hallucinogens,” which
includes lysergic acid diethylamide (LSD), dimethyl-
tryptamine (DMT), STP (phencyclidine and 2,5-
Dimethoxy-4-methylamphetamine), mescaline,
psilocybin, and peyote.
Among the clients shown in exhibit 22, the gamma
hydroxybutyrate (GHB) clients were the most likely to
be White, phencyclidine (PCP) clients were the most
likely to be Black, Rohypnol® clients were the most
likely to be Hispanic and the youngest, and ketamine
clients were the oldest. Users of PCP were the most
likely to have a primary problem with PCP (55
percent); users of Rohypnol®, ecstasy, and hallucino-
gens were more likely to have primary problems with
marijuana. Users of GHB tended to have a primary
problem with methamphetamine (56 percent), and
ketamine users were the most likely to have a history
of injecting drug use, followed by GHB and steroid
users.
Benzylpiperazine (BZP)
N-Benzylpiperazine (BZP) has pharmacological
effects that are qualitatively similar to those of
amphetamine. It is a Schedule I drug that is often
taken in combination with 1-(3-trifluoromethylphenyl)
piperazine (TFMPP), a noncontrolled substance, in
order to enhance its effects as a substitute for
MDMA. It is generally taken orally, but can be
smoked or inhaled. Piperazines are a broad class of
chemicals which include several stimulants (BZP,
TFMPP, etc) as well as anti-vertigo agents (cyclizine,
meclizine) and others (sildenafil/Viagra®).
A major seizure of 147,000 suspected MDMA tablets
in Texas in 2008 found the tablets were benzyl-
piperazine, TFMPP, and methorphan.
There were 312 items submitted to DPS laboratories
in 2008 that were identified as BZP and 66 that were
TFMPP. In comparison, in 2007, there were 19 BZP
exhibits and 2 TFMPP.
Dextromethorphan (DXM)
The most popular dextromethorphan (DXM) products
are Robitussin-DM®, Tussin®, and Coricidin Cough
and Cold Tablets HBP®, which can be purchased
over the counter and can produce hallucinogenic
effects if taken in large quantities. Coricidin HBP®
pills are known as “Triple C” or “Skittles.”
The 2008 Texas school survey reported that 3
percent of secondary students indicated they had
ever used DXM, and 2 percent had used in the past
year. The 2005 Texas college survey found that 5
percent had ever used DXM, and less than 1 percent
had used it in the past month.
13
Poison control centers reported the number of abuse DPS labs examined 2 substances in 1998 that were
and misuse cases involving DXM rose from 99 in DXM, compared with 13 in 1999; 36 in 2000; 18 in
1998 to 467 in 2008. The average age was 21. The 2001; 42 in 2002; 10 in 2003; 15 in 2004; 10 in 2005;
number of cases involving abuse or misuse of 12 in 2006; 5 in 2007; and 9 in 2008.
Coricidin HBP® was 7 in 1998; 189 in 2005; 288 in
2006; 483 in 2007; and 158 in 2008. The average In Lubbock, street outreach workers report some
age in 2008 was 18, which shows that youth can youths are taking 10-16 Triple C or CCC pills at a
easily access and misuse this substance. time to achieve hallucinogenic effects.
There were 12 deaths in 2007 in which DXM was
one of the substances mentioned on the death
certificate.
Exhibit 22. Characteristics of Clients Admitted to DSHS-Funded Treatment
with a Primary, Secondary, or Tertiary Problem with Club Drugs: 2008

Club Drug GHB Hallucinogens Ecstasy PCP Rohypnol Ketamine Steroids

# Admissions 113 404 1189 880 207 14 20
Average Age (Years) 32 25 24 28 20 35 31
% Male 50 68 57 48 77 71 85
% Black 6 29 38 85 1 7 5
% White 84 51 39 7 4 36 75
% Hispanic 6 17 22 8 94 57 20
% History Needle Use 54 18 10 4 20 100 45
% Criminal Justice Involved 69 73 79 67 76 21 75
% Primary Drug=Club Drug 20 35 18 55 18 50 35
Other Primary Drug
% Marijuana 3 33 44 21 43 0 20
% Alcohol 5 10 7 5 4 0 25
% Methamphet/Amphetamines 56 7 7 1 1 14 0
% Powder Cocaine 2 5 12 9 7 0 10
% Crack Cocaine 0 5 3 6 6 0 0
% Heroin 4 1 1 0 19 21 10
% Other Opiates 9 2 2 1 1 0 0

Ecstasy ( MDMA, MDA) significant increase from 8 percent in 2005. The

2005 Texas college survey found
Exhibit 23. Texas Poison Control Calls, Treatment Admissions, Lab
Exhibits, and Ecstasy Deaths: 1998-2008 that 9 percent of college students had ever used
ecstasy, and less than 1 percent had used in the
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 past year. The 2004–2006 NSDUH survey reported
10000 1.1 percent of Texans had used ecstasy in the past
year.
Logarithmic Scale

1000

The Texas Poison Center Network reported 23 calls

100
involving misuse or abuse of ecstasy in 1998,
10 compared with 46 in 1999; 119 in 2000; 155 in 2001;
172 in 2002; 284 in 2003; 302 in 2004; 343 in 2005;
1 292 in 2006; 232 in 2007; and 293 in 2008 (exhibit
# PCC Calls # Treatment # DPS Lab Items # Deaths 23). In 2008, the average age was 22.

Ecstasy is often used in combination with other

The 2008 Texas secondary school survey reported drugs, and the increase in use and abuse of the drug
that lifetime ecstasy use dropped from a high of 9 is demonstrated in the increases in the numbers of
percent in 2002 to 5 percent in 2008, while past-year clients seeking treatment who report a primary,
use dropped from 3 to 2 percent during that time. secondary, or tertiary problem with ecstasy (exhibit
The 2007 YRBS reported that 10 percent of Texas 23). In 1998, there were 63 of these polydrug
high school students had ever used ecstasy, a

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 14

admissions, as compared with 114 in 1999; 199 in
2000; 349 in 2001; 521 in 2002; 502 in 2003; 561 in
2004; 640 in 2005; 1,212 in 2006; 1,247 in 2007; and
1,189 in 2008. Exhibit 24 shows that ecstasy has
spread outside the White rave scene and into the
Hispanic and Black communities, as evidenced by
the fact that only 39 percent of the clients in 2008
were White.
Exhibit 24. Characteristics of Clients Admitted to DSHS-
Funded Treatment with a Primary Problem with Ecstasy: 1989-
2008
100%
80%
White
60%
Hispanic
40%
Black
20%
0%
90
92
94
96
98
00
02
04
06
08
19
19
19
19
19
20
20
20
20
20
Source: DSHS
In 1999, there were two death certificates that
mentioned ecstasy or MDMA in Texas. There was 1
death in 2000, compared with 5 in 2001; 5 in 2002; 2
in 2003; 9 in 2004; 11 in 2005; 15 in 2006; and 6 in
2007 (exhibit 23). Of the 2007 deaths, 67 percent
were male, 50 percent were White, 17 percent were
Hispanic, 33 percent were Black, and the average
age was 24.
The DPS labs identified methylenedioxymeth-
amphetamine (MDMA) in 5 exhibits in 1998; 107
exhibits in 1999; 387 in 2000; 817 in 2001; 63 in
2002; 490 in 2003; 737 in 2004; 821 in 2005; 1,173
in 2006; and 1,134 in 2007; and 1,011 in 2008.
Methylenedioxyamphetamine (MDA) was identified
in no exhibits in 1998; 31 in 1999; 27 in 2000; 60 in
2001; 106 in 2002; 94 in 2003; 67 in 2004; 85 in
2005; 80 in 2006; 43 in 2007; and 63 in 2008.
The Dallas DEA FD reported wholesale distribution
was dominated by ethnic Vietnamese, while retail
level distribution was conducted mainly by younger
White males. The mid-level distributors were
reported being quick to establish new sources and
the availability of the drug (or counterfeits) was
expected to remain readily available. According to
the Houston DEA FD, ecstasy was readily available,
with Vietnamese and Chinese operators controlling
trafficking. The drug was imported from Canada with
smaller amounts coming in from Europe.
Single dosage units of ecstasy sold for $20 in
Houston, $4 in McAllen, $20 in Laredo, $12–$20 in
Dallas, and $10–$15 in Lubbock.
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
Gamma Hydroxybutyrate (GHB), Gamma
Butyrate Lactone (GBL), 1-4 Butanediol (1,4 BD)
The 2005 Texas college survey reported that 2
percent of the students had ever used GHB, and
none reported past-month use.
The number of cases of misuse or abuse of GHB or
its precursors reported to the Texas Poison Center
Network was 110 in 1998; 150 in 1999; 120 in 2000;
119 in 2001; 100 in 2002; 66 in 2003; 84 in 2004; 62
in 2005; 43 in 2006; 56 in 2007; and 49 in 2008. The
average age of the abusers in 2008 was 30.
Adults and adolescents with a primary, secondary, or
tertiary problem with GHB, GBL, or 1,4 BD have been
admitted to DSHS-funded treatment. In 1998, there
were 2 clients, compared with 17 in 1999; 12 in 2000;
19 in 2001; 33 in 2002; 31 in 2003; 45 in 2004; 48 in
2005; 111 in 2006; 103 in 2007; and 113 in 2008. In
2008, clients who used GHB tended to be older
(average age 32) and were more likely to be White
(84 percent) (exhibit 22). GHB users were more likely
to have used the so-called “hard-core” drugs: 54
percent had a history of injection drug use (IDU) and
56 percent had a primary problem with amphetamines
or methamphetamine. Because of the sleep-inducing
properties of GHB, users will also use metham-
phetamine to stay awake while they are “high” on
GHB, or they use GHB to “come down” from their use
of methamphetamine.
There were three deaths that involved GHB in 1999,
compared with five in 2000, three in 2001, two in
2002, two in 2003, three in 2004, three in 2005, one
in 2006, and two in 2007.
There were 18 items identified by DPS labs as being
GHB in 1998, compared with 112 in 1999; 45 in
2000; 34 in 2001; 110 in 2002; 150 in 2003; 99 in
2004; 92 in 2005; 89 in 2006; 56 in 2007; and 57 in
2008. There were no items identified as GBL in
1998, compared with four in 1999; seven in 2000;
seven in 2001; nine in 2002; five in 2003; two in
2004; one in 2005; nine in 2006; none in 2007; and
three in 2008. There were no items identified as 1,4
BD in 1988, compared with 4 in 1989; 4 in 2000; 19
in 2001; five in 2002; and none in 2003, 2004, 2005,
2006, 2007, or 2008.
In Houston, GHB sold for $5–$10 per dosage unit
and $725–$1,000 per gallon. In Dallas, it sold for $20
per dosage unit and $500–$1,600 per gallon.
Ketamine
The 2005 Texas college survey found that 2 percent
of the students had ever used ketamine, and none
reported past-month use.
15
Eight cases of misuse or abuse of ketamine were
reported to Texas Poison Control Centers in 1998,
compared with 7 in 1999; 15 in 2000; 14 in 2001; 10
in 2002; 17 in 2003; 7 in 2004; 5 in 2005; 3 in 2006;
1 in 2007; and one in 2008.
In 2008, there were 14 admissions to treatment with
a primary, secondary, or tertiary problem with
ketamine. The average age was 35, 71 percent were
male, 100 percent had an IDU history, 36 percent
were White, 57 percent were Hispanic, and 7 percent
were Black (exhibit 22). While 50 percent had a
primary problem with ketamine, 21 percent had a
primary problem with heroin and 14 percent had a
primary problem with methamphetamine and a
secondary or tertiary problem with ketamine.
There were two deaths in 1999 that involved use of
ketamine, compared with none in 2000; one in 2001;
one in 2002; none in 2003; two in 2004; one in 2005;
none in 2006; and two in 2007.
In 1998, two substances were identified as ketamine
by DPS labs. There were 26 items identified in 1999;
49 in 2000; 120 in 2001; 116 in 2002; 85 in 2003; 79
in 2004; 19 in 2005; 140 in 2006; 154 in 2007; and
76 in 2008.
Ketamine cost $2,200–$2,500 per liter in Fort Worth
and $65 per vial in Tyler, with a dose selling for $20
per pill or gram in Tyler, $20–$40 in Lubbock, and
$15–$20 in San Antonio.
Lysergic Acid Diethylamide (LSD) and Other
Hallucinogens
The Texas secondary school survey showed that
use of hallucinogens (defined as LSD, PCP,
mushrooms, etc.) continued to decrease. Lifetime
use peaked at 7.4 percent in 1996 and dropped to
4.4 percent in 2008. Past-month use dropped from a
peak of 2.5 percent in 1998 to 1.5 percent in 2008.
The 2005 Texas college survey found that 10
percent of college students had ever used
hallucinogens, and less than 1 percent had used in
the past month. The 2002–2004 NSDUH reported
past-year use by Texans age 12 and older at 0.3
percent.
The Texas Poison Center Network reported 82
mentions of abuse or misuse of LSD in 1998,
compared with 113 in 1999; 97 in 2000; 70 in 2001;
129 in 2002; 20 in 2003; 22 in 2004; 38 in 2005; 33 in
2006; 31 in 2007; and 17 in 2008. There were also 98
cases of intentional misuse or abuse of hallucinogenic
mushrooms reported in 1998; 73 in 1999; 110 in 2000;
94 in 2001; 151 in 2002; 130 in 2003; 172 in 2004; 82
in 2005; 96 in 2006; 125 in 2007; and 93 in 2008. The
average age in 2008 was 20 for the LSD cases and
21 for the mushroom cases.
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
The number of adults and youths with a primary,
secondary, or tertiary problem with hallucinogens
entering treatment has increased since 2005. There
were 636 admissions in 2000; 486 in 2001; 436 in
2002; 319 in 2003; 266 in 2004; 223 in 2005; 338 in
2006; 370 in 2007; and 404 in 2008. Of the
hallucinogen admissions in 2008, the average age
was 25, 68 percent were male, 51 percent were
White, 17 percent were Hispanic, and 29 percent
were Black. Seventy-three percent were referred
from the criminal justice or legal system, and 18
percent had an IDU history (exhibit 22).
Statewide, there were two deaths in 1999 with a
mention of LSD. No deaths with a mention of LSD
have been reported since then.
DPS labs identified 69 substances as LSD in 1998,
compared with 406 in 1999; 234 in 2000; 122 in
2001; 11 in 2002; 10 in 2003; 25 in 2004; 14 in 2005;
1 in 2006; 29 in 2007; and 19 in 2008.
A dosage unit of LSD sold for $1–$10 in Dallas, $7 in
Lubbock, and $8–$12 in San Antonio. Psilocybin
mushrooms sold for $10–$14 per gram in Lubbock.
Phencyclidine (PCP)
Exhibit 25. Texas Poison Control Calls, Treatment Admissions, Lab
Exhibits, and PCP Deaths: 1998-2008
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
1000
Logarithmic Scale
100
10
1
# PCC Calls # Treatment # DPS Items # Deaths
Ex amined
The 2002–2004 NSDUH reported past-year use of
PCP in Texas at 0.1 percent.
The Texas Poison Center Network reported cases of
“Fry,” “Amp,” “Water,” "Wet," “Wack,” “PCP,” or
formaldehyde. Often, marijuana joints are dipped in
formaldehyde that contains PCP, or PCP is sprinkled
on the joint or cigarette. The number of poison cases
involving PCP increased from 102 in 1998 to 290 in
2008 (exhibit 25).
Exhibit 25 shows the increases in the number of
clients entering treatment with a primary problem
with PCP. Of the clients in 2008, 85 percent were
Black, 48 percent were male, and 67 percent were
involved in the criminal justice system. While 55
percent reported a primary problem with PCP,
16
another 21 percent reported a primary problem with
marijuana, which demonstrates the link between
these two drugs (exhibit 22).
There were eight death certificates in 2007 that
mentioned PCP (exhibit 25).
DPS labs identified 10 substances as PCP in 1998
and 216 in 2008 (exhibit 25).
According to the DEA, PCP cost $375–$450 per
ounce in Dallas. A gallon cost $5,500 in Dallas and
$20,000-$30,000 in Houston.
PCP use was reported by street outreach workers to
be increasing among youths and young adults age
16-30.
Rohypnol®
Rohypnol® (flunitrazepam) is a benzodiazepine that
was never approved for use in the United States.
The drug is legal in Mexico, but since 1996, it has
been illegal to bring it into the United States.
Rohypnol® continues to be a problem along the
Texas–Mexico border. The 2008 secondary school
survey found that students from the border area
were about three times more likely to report
Rohypnol® use than those living elsewhere in the
State (6 percent versus 2 percent lifetime, and 2
percent versus 1 percent current use). Use in both
the border and nonborder areas has declined since
its peak in 1998. Among Texas college students in
2005, 1 percent reported lifetime use of Rohypnol®,
and none reported past-month use.
The number of confirmed exposures to Rohypnol®
reported to the Texas Poison Control Centers
peaked at 102 in 1998; 22 in 2005; 10 in 2006; 11 in
2007; and 12 in 2008. The average age in 2008 was
19, 42 percent were male, and 66 percent lived in
counties on the border.
The number of youths and adults admitted into
treatment with a primary, secondary, or tertiary
problem with Rohypnol® has varied: 247 in 1998;
364 in 1999; 324 in 2000; 397 in 2001; 368 in 2002;
331 in 2003; 221 in 2004; 198 in 2005; 278 in 2006;
272 in 2007; and 207 in 2008. In 2008, clients
abusing Rohypnol® were among the youngest of the
club drug clients (age 20), and they were mostly
Hispanic (94 percent), reflecting the availability and
use of this drug along the border. Seventy-six
percent were involved with the criminal justice or
legal system. While 18 percent of these clients said
that Rohypnol® was their primary problem drug, 43
percent reported a primary problem with marijuana,
and 19 percent had a problem with heroin (exhibit
22).
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
DPS lab exhibits for flunitrazepam numbered 43 in
1988; 56 in 1999; 32 in 2000; 33 in 2001; 26 in 2002;
17 in 2003; 17 in 2004; 10 in 2005; 9 in 2006; 1 in
2007; and 0 in 2008.
Rohypnol® sold for $2–$4 per pill in San Antonio in
2008.
OTHER ABUSED SUBSTANCES
Inhalants
The 2008 elementary school survey found that 9
percent of students in grades 4–6 had ever used
inhalants, and 7 percent had used in the school year.
The 2008 secondary school survey found that 9
percent of students in grades 7–12 had ever used
inhalants, and 3 percent had used in the past month.
Inhalant use exhibits a peculiar age pattern not
observed with any other substance. The prevalence
of lifetime and past-month inhalant use was higher in
the lower grades and lower in the upper grades
(exhibit 27). This decrease in inhalant use as
students age may be partially related to the fact that
inhalant users drop out of school early and are not in
school in later grades to respond to school-based
surveys. In addition, the Texas school surveys have
consistently found that eighth graders reported use
of more different kinds of inhalants than any other
grade; this may be a factor that exacerbates the
damaging effects of inhalants and leads to dropping
out.
Exhibit 27. Percentage of Texas Secondary Students
Who Had Used Inhalants Ever or in the Past Month, by
Grade: 2008
Lifetime Use Past-Month Use
12% 11% 11%
9% 10%
10%
8%
8% 7%
6%
4%
2%
0%
Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12
Source: DSHS
The 2007 YRBS reported that 12.9 percent of Texas
high school students had ever used inhalants.
Respondents to the 2005 Texas college survey
reported 4 percent lifetime and 0.3 percent past-
month use of inhalants. The 2002–2004 NSDUH
estimated that 0.7 percent of Texas age 12 and older
had used inhalants in the past year.
Out of the 77 calls to the poison control centers in
17
2008 that involved human exposure to the inhalation
of chemicals, there were 12 calls for exposure to
automotive products such as carburetor cleaner,
transmission fluid, and gasoline, 30 calls for misuse
of air fresheners or dusting sprays containing
tetrafluoroethane or difluoroethane, 20 calls for abuse
or misuse of paint or toluene, and 4 calls involving
gases such as butane, helium, nitrous oxide, or
propane.
Inhalant abusers represented 0.1 percent of the
admissions to treatment programs in 2008. The
clients tended to be male (72 percent) and Hispanic
(64 percent). The over-representation of Hispanics is
related to the fact that DSHS developed and funded
treatment programs targeted specifically to this
group. The average age of the clients was 25. Forty-
nine percent were involved with the criminal justice
system, the average education was 10.2 years, 14
percent were homeless, and 11 percent had a
history of injection drug use (appendix 1). Of the
inhalant abusers, 27 percent reported no secondary
drug problem, 27 percent had a second problem with
marijuana, and 26 percent had a second problem
with alcohol.
The categorization of inhalant deaths is difficult and
leads to underreporting. In 2000, there were 12
death certificates that reported inhalants, compared
with 15 in 2001; 8 in 2002; 13 in 2003; 11 in 2004; 17
in 2005; 4 in 2006; and 28 in 2007. Six of the 2007
deaths involved inhaling tetrafluoroethane or
difluoroethane, ingredients used in computer dusters.
Steroids
The Texas school survey reported that 1.5 percent of
all secondary students surveyed in 2008 had ever
used steroids, and 0.5 percent had used steroids
during the month before the survey. The 2007 YRBS
found lifetime use among Texas students in grades
9–12 was 3.9 percent, with 4.8 percent among boys
and 3.0 percent among girls. The 2005 Texas college
survey found less than 1 percent had ever used
steroids, and 0.1 percent had used in the past month.
There were 20 persons admitted to DSHS-funded
treatment in 2008 with a primary, secondary, or
tertiary problem with steroids. Eighty-five percent
were male, 75 percent were White, and 20 percent
were Hispanic, the average age was 31. Seventy-five
percent were involved with the criminal justice or
legal system, 35 percent had a primary problem with
steroids, and 25 percent had a primary problem with
alcohol (exhibit 22).
The NFLIS data for Texas reported testosterone was
the steroid most likely to be identified in forensic
testing, although it only constituted 0.14 percent of all
the items tested in 2008. Dallas DEA reported that
GCATTC: Promoting Quality Treatment Through Evidence-Based Practices
Mexico was the source for anabolic steroids and
China was the source of human growth hormone
(HGH).
Carisoprodol (Soma®)
Poison control centers confirmed that exposure
cases of intentional misuse or abuse of the muscle
relaxant carisoprodol (Soma®) increased from 83 in
1998 to 390 in 2008. Fifty-three percent were male
and average age was 34.
In 2007, carisoprodol was mentioned on 208 death
certificates, up from 51 in 2003. Only four of the
2007 death certificates mentioned only carisoprodol;
all the others listed combinations of drugs.
Hydrocodone and alprazolam were substances most
often mentioned on the other carisoprodol death
certificates. Of the 2007 deaths, 50 percent were
male and the average age was 39.
DPS lab exhibits of carisoprodol reported to NFLIS
increased from 13 in 1998 to 90 in 1999; 153 in
2000; 202 in 2001; 232 in 2002; 277 in 2003; 253 in
2004; 336 in 2005; 558 in 2006; 700 in 2007; and
471 in 2008. According to the Dallas DEA Field
Division, Soma® and Soma® with codeine sold for
$2–$5 per tablet.
DRUG ABUSE PATTERNS ON THE TEXAS-MEXICO
BORDER
The 2008 Texas Secondary School Survey reported
that students living in counties along the Texas
border were more likely to report lifetime use of
tobacco (33 percent versus 31 percent nonborder),
powder cocaine (10 percent versus 6 percent), crack
cocaine (3 percent versus 2 percent), and Rohypnol®
(6 percent versus 2 percent), while nonborder
students were more likely to report use of marijuana
(25 percent versus 22 percent border), alcohol (63
percent versus 61 percent), alprazolam (14 percent
versus 8 percent), ecstasy (5 percent versus 4
percent), and methamphetamine (4 percent versus 3
percent). One percent of each group reported lifetime
use of heroin.
When asked which substances were very easy to
obtain, border students reported Rohypnol® (12
percent versus 6 percent), powder cocaine (16
percent versus 11 percent), and crack cocaine (11
percent versus 8 percent), while nonborder students
reported tobacco (40 percent versus 32 percent),
alcohol (47 percent versus 39 percent), and
marijuana (26 percent versus 23 percent).
Different patterns were also seen in border and
nonborder admissions to DSHS-funded treatment in
2008. While the proportion of admissions with a
primary problem with heroin was similar (12 percent
18
border versus 11 percent nonborder), border clients Exhibit 27. Admissions to Texas DSHS-Funded Treatment:
were more likely to report problems with alcohol (31 Nonborder 1996-2008
percent versus 27 percent nonborder), powder Methamp Heroin Marijuana Powder Cocaine Crack Cocaine

cocaine (21 percent versus 9 percent), and marijuana 30

(27 percent versus 23 percent). Nonborder clients 25
were more likely to report problems with other opiates

% of All Admissions
20
(6 percent versus 1 percent nonborder),
15
methamphetamine (9 percent versus 1 percent), and
crack cocaine (12 percent versus 6 percent). In 10

addition to differences in primary problem, nonborder 5

clients were older (33 years versus 30 years), less 0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
likely to be first admissions (48 percent versus 62 Source: DSHS

percent), less likely to be male (60 percent versus 64

percent), less likely to be employed (31 percent The DPS laboratory in El Paso in 2008 reported 69
versus 40 percent), more likely to be homeless (11 percent of the items examined were marijuana, 20
percent versus 5 percent), and more likely to have a percent cocaine, and 1 percent heroin. In Laredo, 59
history of injection drug use (27 percent versus 17 of the items examined were marijuana, 26 percent
percent). The nonborder clients reported more days were cocaine, and 5 percent heroin. In McAllen, 62
of problems on the ASI Index in the month prior to percent of the items examined were cocaine, 17
admission than did border admissions. percent were marijuana, and 0.3 percent heroin.

Over time, the drug use problems have changed on While poverty, unemployment, lack of social services
the border and in the nonborder areas. Exhibit 26 and drug treatment programs to meet the increasing
shows the increase in use of marijuana and powder demand, drug trafficking, and cartels and gangs are
cocaine, the decrease in heroin, and the low levels of not new to the border, street outreach workers have
use of crack cocaine and methamphetamine on the reported increasing fear, trauma, and mental health
border. In comparison, in the nonborder areas, the issues related to loss of partners and parents. There
use of crack cocaine was high but has decreased, is less ability to coordinate services across the
while the use of marijuana has increased. Use of border, while at the same time there is an increasing
methamphetamine peaked in 2005 (exhibit 27). need for greater collaboration. There were growing
concerns by workers about their personal safety in
The drug problem also differs in cities along the providing substance abuse services in communities
border. The primary problems at treatment admission which are experiencing increases in violence and
in El Paso in 2008 were marijuana and cocaine (24 crimes related to drugs. The workers also reported
percent each), and heroin (14 percent). In Laredo, 38 increasing numbers of youth involved in drug
percent of the admissions were for marijuana, 22 trafficking and fewer options for these youth.
percent for cocaine, and 21 percent for heroin. In Choosing whether or not to become involved in drugs
McAllen, 38 percent of the admissions were for and gangs seemed less like a choice and more like a
cocaine, 23 percent for marijuana, and 11 percent for decision based on threats and fear. There was also
heroin. These variations were due both to historical concern that people in need of substance abuse and
funding decisions (the largest methadone program in mental health services were becoming more
El Paso is not state-funded and does not report “closeted” and afraid to ask for help due to
treatment data and there is an adolescent residential repercussions related to the safety of their families
program in Laredo) and to trafficking patterns. and/or immigration issues.

Exhibit 26. Admissions to Texas DSHS-Funded Treatment: INFECTIOUS DISEASES RELATED TO DRUG ABUSE
Border 1996-2008

Methamp Heroin Marijuana Powder Cocaine Crack Cocaine Forty-eight percent of the 200 clients in Texas
35 narcotic treatment programs said they were positive
30 for hepatitis C (HCV), and 54 percent said a doctor
% of All Admissions

25 had told them they had liver problems (Maxwell &

20 Spence, 2006). DSHS estimates that 1.8% of Texans
15 are infected with HCV. There are approximately
10 368,000 cases of hepatitis C in Texas, 80 percent of
5 which (about 300,000) are chronic (long-lasting)
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
infections. In Texas, estimates also indicate that
Source: DSHS there may be a greater disease burden among
Blacks (2.2%), and Hispanics (2.0%) people. Whites
have the lowest estimated infection rate (1.4%).

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 19

Although most cases of infection occur in and around
Exhibit 29. AIDS Cases in Texas by Mode of Exposure:
large urban areas, a disproportionate amount of the 1987–2008 (Cases with Risk Not Classified Excluded)
disease happens along the Texas/Mexico border. 90%
80%
The case rate for syphilis increased from 3.5 per 70%
100,000 in 1997 to 4.9 in 2007. The case rate for 60% MSM
50%
Chlamydia increased from 260.7 per 100,000 in 1997 IDU
40%
to 562.0 in 2007, and the case rate for gonorrhea M-M & IDU
30%
decreased from 136.9 per 100,000 in 1997 to 133.0 20%
Hetero
in 2007. 10%
0%
HIV/AIDS outreach workers were reporting

87

90

93

96

99

02

05

08
increasing numbers of cases of syphilis and

19

19

19

19

19

20

20

20
untreated HCV and HIV cases. Source: DSHS

HIV/AIDS Cases
Exhibit 30. Texas Male and Female HIV Cases by Race/Ethnicity:
The proportion of HIV cases among men having sex 1999-2008
100%
with men (MSM) increased from 46 percent in 1999 90%
to 65 percent in 2008 (exhibit 28), and the proportion 80% Hispanic Male
of AIDS cases among MSM decreased from 81 70%
percent in 1987 to 59 percent in 2008 (exhibit 29). Of Black Male
60%
the HIV cases in 2008, 23 percent were heterosexual White Male
50%
mode of exposure, and 10 percent were IDUs. Of the Hispanic Female
40%
2008 AIDS cases, 25 percent were heterosexual and 30% Black Female
12 percent were IDUs. HIV cases that later 20% White Female
seroconverted to AIDS are excluded from the HIV 10%
exhibits. The proportions of cases involving IDU or 0%
IDU/MSM have decreased over time. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: DSHS
Persons infected with HIV or AIDS were increasingly
more likely to be people of color. Among HIV cases in Exhibit 31. Texas Male and Female AIDS Cases by Race/Ethnicity:
2008, 45 percent were Black, 27 percent were White, 1987– 2008
and 26 percent were Hispanic (exhibit 30). Among 100%

AIDS cases in 2008, 42 percent were Black, 28

80% Hispanic Male
percent were White, and 28 percent were Hispanic
(exhibit 31). Black Male
60%
White Male

The proportion of adult IDUs entering DSHS-funded 40% Hispanic Female

treatment programs decreased from 32 percent in Black Female

20% White Female
1988 to 16 percent in 2008. In 2008, 60 percent of
heroin injectors were people of color (exhibit 9), while
0%
injectors of cocaine (exhibit 3) and of stimulants
87

89

91

93

95

97

99

01

03

05

07

(exhibit 19) were far more likely to be White.

19

19

19

19

19

19

19

20

20

20

20

Source: DSHS

Exhibit 28. Percent HIV Cases by Selected Modes of Exposure:

1999-2008 (Cases with Risk Not Classified Excluded)

70%

60%

50%

40% MSM
IDU
30%
MSM/IDU
20% Hetero

10%

0%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: DSHS

GCATTC: Promoting Quality Treatment Through Evidence-Based Practices 20

Appendix 1. Characteristics of Clients at Admission to DSHS-Funded Treatment Programs by Primary
Problem Substanced that Caused Them to Seek Treatment: January-December 2008

Percent Average Ave Lag Pct No

Total Of All Average Age 1st Use to Prior Percent Percent
Primary substance Admissions Admissions Age 1st Use Admission Treatment Married Male
88871 100 32.9 18.7 14 48.9 18.1 60.4
Heroin 9945 11.2 33.4 20.9 12 27.0 16.0 62.2
Non-Rx Methadone 160 0.2 34.3 24.7 8 22.5 11.9 45.6
Other opiates 5221 5.9 34.4 24.3 10 38.2 21.4 42.3
Alcohol 23928 26.9 38.2 15.6 23 46.9 18.2 69.9
Barbiturates 70 0.1 30.0 22.0 8 51.4 20.0 48.6
Other sedatives 1201 1.4 29.2 21.6 8 47.4 16.7 35.1
Amphet/Methamph 7458 8.4 32.8 21.1 12 48.3 16.8 44.9
Cocaine(powder) 8087 9.1 31.6 21.0 11 55.3 20.8 52.2
Marijuana 20257 22.8 23.5 14.4 9 68.8 19.8 71.0

Percent Percent w/ Avg Months Pct Involved

Using History of Percent Percent Percent Percent Employed Crim Just/
Primary substance Needles IV Drug Use Black White Hispanic Employed Over Last 12 Legal
Total 15.6 26.3 19.8 46.0 32.8 32.1 3.9 57.5
Heroin 76.5 80.5 8.1 34.7 56 14.5 2.1 32.0
Non-Rx Methadone 18.1 48.8 8.1 79.4 11.9 23.8 3.2 30.6
Other opiates 13.7 32.7 9.3 76.7 12.7 17.8 3.4 35.1
Alcohol 4.5 18.5 11.9 56.1 30.3 33.3 4.8 53.2
Barbiturates 7.1 24.3 15.7 58.6 21.4 30 3.4 57.1
Other sedatives 4.1 17.8 12.5 68.1 17.6 20.1 3.1 53.6
Amphet/Methamph 33.8 46.1 2 85 11.4 29.2 3.6 67.5
Cocaine(powder) 10.9 17 18.5 30.1 50.1 35 4.1 62.9
Marijuana 1.4 5.1 28.3 28.7 41.5 53.3 4.9 80.9

Average # Women Percent Pct Sickness

Average Percent Income Pregnant Percent on Emergency or Health
Primary substance Education Homeless At Adm at Admission Medication Room Visit Problems
Total 11.4 10.3 $7,135 1718.0 22.7 29.4 22.9
Heroin 11.3 13.1 $3,266 262.0 28.6 29.2 29.7
Non-Rx Methadone 11.7 10.6 $5,570 4.0 25.0 38.1 42.5
Other opiates 12.1 6.9 $6,613 60.0 31.8 44.5 35.7
Alcohol 11.9 13.0 $10,012 169.0 24.0 34.0 25.4
Barbiturates 11.8 8.6 $4,633 2.0 41.4 40.0 30.0
Other sedatives 11.7 6.3 $6,776 46.0 31.7 42.8 26.7
Amphet/Methamph 11.7 7.8 $6,347 216.0 20.9 30.9 21.1
Cocaine(powder) 11.3 5.6 $7,526 255.0 18.5 28.3 18.0
Marijuana 10.5 4.7 $7,699 396.0 13.2 15.1 12.1

Pct w/ Pct w/Family Pct w/ Pct w/ Pct w/

Employment and/or Marital Social/Peer Psych/Emot. Drug/Alcohol
Primary substance Problems Problems Problems Problems Problems
Total 45.7 44.1 37.5 35.7 58.6
Heroin 70.5 66.3 61.4 46.1 83.6
Non-Rx Methadone 60.6 58.8 56.9 63.1 85.6
Other opiates 59.5 60.9 53.6 54.1 78.3
Alcohol 47.5 46.0 40.9 39.2 60.6
Barbiturates 42.9 35.7 21.4 40.0 41.4
Other sedatives 50.1 50.7 42.2 44.0 62.1
Amphet/Methamph 43.2 41.3 32.6 37.2 55.0
Cocaine(powder) 35.8 37.4 26.9 29.8 47.7
Marijuana 28.6 25.8 19.6 17.0 40.3
 Percent Average Ave Lag Pct No
Total Of All Average Age 1st Use to Prior Percent Percent
Primary substance Admissions Admissions Age 1st Use Admission Treatment Married Male
Hallucinogens 141 0.2 27.2 18.9 9 44.7 11.3 59.6
Inhalants 81 0.1 25.0 16.8 9 45.7 18.5 71.6
Over-the-counter drug 25 0.0 26.0 20.9 5 60.0 16.0 60.0
Tranquilizers 105 0.1 28.2 19.1 8 52.4 17.1 25.7
Other 187 0.2 34.2 11.0 22 74.9 19.3 40.6
Ecstasy 214 0.2 24.9 19.8 5 53.7 15.0 53.7
Anabolic steroids 7 0.0 32.0 18.7 13 57.1 42.9 85.7
Rohypnol 37 0.0 19.1 14.6 4 62.2 27.0 59.5
Crack 11160 12.6 39.1 25.4 14 37.6 15.0 48.7
Ephedrine 2 0.0 44.0 31.5 13 0.0 0.0 50.0

Percent Percent w/ Avg Months % Involved

Using History of Percent Percent Percent Percent Employed Crim Just/
Primary substance Needles IV Drug Use Black White Hispanic Employed Over Last 12 Legal
Hallucinogens 14.2 22.7 47.5 34.0 14.9 25.5 2.7 65.2
Inhalants 8.6 11.1 6.2 25.9 64.2 30.9 2.0 49.4
Over-the-counter 4.0 16.0 8.0 72.0 16.0 32.0 3.5 56.0
Tranquilizers 2.9 22.9 15.2 70.5 13.3 14.3 2.6 57.1
Other 0.5 4.8 27.3 47.1 22.5 20.3 2.4 34.8
Ecstasy 1.9 6.1 51.9 29.4 17.8 33.2 2.6 81.8
Anabolic steroids 14.3 28.6 0.0 71.4 28.6 28.6 4.6 57.1
Rohypnol 2.7 8.1 0.0 5.4 94.6 51.4 2.1 75.7
Crack 5.6 26.3 46.4 35.8 16.8 15.3 2.5 47.1
Ephedrine 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0

Average # Women Percent % Sickness

Average Percent Income Pregnant Percent on Emergency or Health
Primary substance Education Homeless At Adm at Admission Medication Room Visit Problems
Hallucinogens 11.0 7.1 $3,230 2 24.1 28.4 19.9
Inhalants 10.2 13.6 $3,401 0 30.9 21.0 18.5
Over-the-counter 10.6 8.0 $5,298 0 32.0 12.0 32.0
Tranquilizers 11.0 15.2 $5,730 2 42.9 44.8 30.5
Other 11.2 10.7 $2,753 4 42.2 38.0 42.8
Ecstasy 11.4 2.8 $3,547 8 16.4 18.7 10.3
Anabolic steroids 10.6 0.0 $6,499 0 14.3 14.3 0.0
Rohypnol 9.6 5.4 $1,392 1 21.6 21.6 13.5
Crack 11.6 19.4 $4,717 280 30.4 36.4 28.8
Ephedrine 11.5 0.0 $3,600 0 100.0 50.0 0.0

Pct w/ Pct w/Family Pct w/ Pct w/ Pct w/

Employment and/or Marital Social/Peer Psych/Emot. Drug/Alcohol
Primary substance Problems Problems Problems Problems Problems
Hallucinogens 34.8 30.5 27.0 35.5 43.3
Inhalants 42.0 48.1 33.3 40.7 63.0
Over-the-counter 36.0 52.0 28.0 32.0 40.0
Tranquilizers 38.1 40.0 33.3 52.4 58.1
Other 66.3 66.3 66.3 70.1 29.9
Ecstasy 31.3 26.2 20.1 22.0 35.0
Anabolic steroids 57.1 42.9 28.6 42.9 71.4
Rohypnol 43.2 51.4 35.1 27.0 73.0
Crack 52.6 52.1 44.5 45.8 67.1
Ephedrine 50.0 50.0 50.0 100.0 100.0
 Percent Average Ave Lag Pct No
Total Of All Average Age 1st Use to Prior Percent Percent
Primary substance Admissions Admissions Age 1st Use Admission Treatment Married Male
GHB 22 0.0 32.0 24.1 9 18.2 4.5 27.3
PCP 487 0.5 28.0 19.4 8 53.6 9.7 39.4
Ketamine 7 0.0 33.4 24.2 11 14.3 28.6 71.4
Klonopin 69 0.1 32.4 24.6 9 31.9 15.9 62.3

Percent Percent w/ Avg Months % Involved

Using History of Percent Percent Percent Percent Employed Crim Just/
Primary substance Needles IV Drug Use Black White Hispanic Employed Over Last 12 Legal
GHB 18.2 50.0 4.5 72.7 9.1 9.1 2.0 86.4
PCP 0.2 1.4 89.5 4.7 5.5 20.3 3.1 64.5
Ketamine 100.0 100.0 0.0 14.3 85.7 14.3 5.1 0.0
Klonopin 1.4 26.1 8.7 56.5 27.5 33.3 1.9 42.0

Average # Women Percent % Sickness

Average Percent Income Pregnant Percent on Emergency or Health
Primary substance Education Homeless At Adm at Admission Medication Room Visit Problems
GHB 12.3 9.1 $2,227 1 50.0 36.4 45.5
PCP 11.3 4.9 $3,774 10 23.4 35.5 18.9
Ketamine 12.7 14.3 $2,041 0 71.4 14.3 42.9
Klonopin 11.3 17.4 $3,636 0 50.7 36.2 31.9

Pct w/ Pct w/Family Pct w/ Pct w/ Pct w/

Employment and/or Marital Social/Peer Psych/Emot. Drug/Alcohol
Primary substance Problems Problems Problems Problems Problems
GHB 68.2 68.2 54.5 68.2 77.3
PCP 41.3 38.0 30.6 30.4 49.3
Ketamine 57.1 42.9 57.1 57.1 71.4
Klonopin 50.7 60.9 58.0 62.3 73.9
Appendix 2

Marijuana Use in Past Year, Cocaine Use in Past Year, and Nonmedical Use of Pain Relievers in Past Year
among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and
2006 National Surveys on Drug Use and Health
Nonmedical Use of Pain Relievers in
Marijuana Use in Past Year Cocaine Use in Past Year Past Year
95% Prediction 95% Prediction 95% Prediction
Estimate Interval Estimate Interval Estimate Interval
Total United States 10.47 (10.24-10.69) 2.38 (2.26-2.49) 4.89 (4.75-5.03)
Texas 8.49 (7.91-9.11) 2.46 (2.16-2.80) 4.66 (4.25-5.10)
Region 1 9.92 (8.02-12.22) 2.84 (2.06-3.90) 5.71 (4.47-7.28)
Region 2 8.21 (6.37-10.53) 2.38 (1.64-3.45) 4.92 (3.73-6.47)
Region 3 8.59 (7.67-9.60) 2.06 (1.63-2.59) 4.98 (4.31-5.75)
Region 4 6.95 (5.50-8.75) 2.24 (1.61-3.11) 4.82 (3.77-6.16)
Region 5 8.67 (6.74-11.08) 2.55 (1.77-3.67) 5.02 (3.81-6.57)
Region 6 7.93 (6.84-9.19) 2.21 (1.76-2.77) 3.78 (3.16-4.53)
Region 7 11.96 (10.49-13.61) 3.26 (2.59-4.08) 5.82 (4.91-6.89)
Region 8 7.73 (6.44-9.25) 2.80 (2.13-3.68) 4.42 (3.52-5.54)
Region 9 6.88 (5.23-9.00) 2.43 (1.69-3.50) 4.79 (3.58-6.38)
Region 10 6.82 (5.23-8.86) 2.66 (1.83-3.85) 4.18 (3.08-5.66)
Region 11 7.26 (5.96-8.81) 2.81 (2.14-3.69) 4.12 (3.30-5.13)

Alcohol Use in Past Month, Binge Alcohol Use in Past Month, and Perceptions of Great Risk of Having Five or
More Drinks of an Alcoholic Beverage Once or Twice a Week among Persons Aged 12 or Older, by Substate
Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 National Surveys on Drug Use and
Health
Perceptions of Great Risk of Having 5
Alcohol Use in Past Month Binge Alcohol Use in Past Month1 or More Drinks Once or Twice a Week
95% Prediction 95% Prediction 95% Prediction
Estimate Interval Estimate Interval Estimate Interval
Total United States 51.01 (50.44-51.58) 22.84 (22.52-23.16) 41.45 (41.06-41.84)
Texas 49.14 (47.75-50.53) 24.02 (22.96-25.11) 44.15 (42.80-45.51)
Region 1 47.53 (42.17-52.95) 26.89 (23.31-30.80) 41.42 (37.20-45.76)
Region 2 46.30 (40.85-51.84) 22.79 (19.25-26.76) 41.52 (37.18-45.99)
Region 3 49.68 (47.31-52.05) 22.69 (21.05-24.43) 42.98 (40.91-45.08)
Region 4 43.24 (38.02-48.61) 21.14 (17.91-24.78) 41.46 (37.34-45.70)
Region 5 42.75 (37.61-48.06) 21.47 (18.13-25.24) 43.14 (38.99-47.38)
Region 6 52.46 (49.76-55.14) 24.10 (22.04-26.29) 44.36 (41.84-46.91)
Region 7 54.78 (51.54-57.97) 25.84 (23.58-28.24) 40.88 (38.15-43.67)
Region 8 47.96 (44.29-51.66) 25.07 (22.28-28.07) 45.89 (42.63-49.18)
Region 9 42.60 (36.85-48.55) 22.21 (18.51-26.41) 47.29 (42.60-52.03)
Region 10 43.75 (38.30-49.35) 25.34 (21.37-29.77) 51.31 (47.10-55.51)
Region 11 43.32 (39.37-47.36) 26.07 (23.27-29.09) 50.02 (46.91-53.12)
1
Binge Alcohol Use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a
couple of hours of each other) on at least 1 day in the past 30 days.